Growth Parameter Assessment

CLINICAL GUIDELINES

Measurements of height, weight, and head circumference may be performed by a registered nurse (RN), a licensed practical nurse (LPN), or unlicensed assistive personnel (UAP) who have received education in the appropriate techniques for growth assessments.
Growth parameter assessments are obtained at each visit to the healthcare provider, at each home visit by the healthcare provider, and on admission to the healthcare facility. If a child is too ill to be measured on admission, measure the child once they recover and prior to discharge.
- Head circumference, weight, and length of infants and children up to 2 years of age.
- Weight, stature (height), and Body Mass Index (BMI) for children and teens from ages 2 through 19 years.
- Length measurements are appropriate for children over the age of 2 who are unable to stand unassisted.
- BMI, an indicator that reveals body weight adjusted for height, is used to assess underweight, overweight, and risk for overweight.
Growth parameter assessment continues throughout the child’s stay in the healthcare facility:
- Daily weights should be obtained in infants as well as children admitted for renal disease, fluid and electrolyte imbalances, cardiac disorders, cystic fibrosis, anorexia, and failure to thrive.
- Daily weights should be assessed at about the same time each day, ideally in the morning before breakfast.
All clinicians in the same setting should use the same measurement techniques to ensure reliability of growth measurements and growth curves.
The same growth charts and measurement instruments should be used for each healthcare visit, thus providing an accurate growth history and illustration of growth trends.

CHILD AND FAMILY ASSESSMENT AND PREPARATION

Assess child’s previous growth pattern and most recent weight, height, and head circumference.
Discuss with the family and child the rationale for growth assessment.
Ensure that the room temperature is adequate for the comfort of the unclothed child.
Ensure measurement instruments are calibrated.
Select growth charts that are age and gender appropriate for the child:
- Birth up to 2 years of age—World Health Organization (WHO) http://www.who.int/childgrowth/ standards/en/
- Children and teens aged 2 through 19—Centers for Disease Control and Prevention (CDC) http://www.cdc. gov/growthcharts/available in French and Spanish

Preterm infants
- NICHD Neonatal Research Network Growth Observational Study (Ehrenkranz, Younes, Lemons, et al., 1999) https://neonatal.rti.org/birth_curves/ dsp_Birthcurves.cfm
- Fetal-Infant Growth Chart for Preterm Infants (Fenton & Kim, 2013) http://www.ucalgary.ca/ fenton/2013chart
- Children with conditions such as Down syndrome, Prader-Willi syndrome, low-birth-weight/premature infants, and Turner syndrome. Washington State Department of Health (2010) http://here. doh.wa.gov/materials/nutrition-interventions/15_ CSHCN-NI_E10 L.pdf

PROCEDURE
Assessing Weight of the Child up to 24 Months of Age

Steps	Rationale/Points of Emphasis
1 Review medical record to note child’s previous weight, if available.	Serves as a baseline to detect weight changes.
2 Perform hand hygiene.	Reduces transmission of microorganisms.
3 Place light drape or paper on scale pan.	Provides comfort and protects from microorganism cross-contamination.
4 Calibrate scale to “0” position.	Negates weight of drape or paper.
5 Completely undress and safely place child on scale. Place the infant in a supine position. Older infants are usually more cooperative with being weighed when allowed to sit on the scale. caREminder	Allows for accurate measurement of child’s body weight.
If available, use of in-bed scales with infants in special care units allows for accurate weight while keeping the infant in a safe temperature-controlled environment.	Allows for accurate measurement of child’s body weight.
caREminder
Children aged 0-24 months should be weighed nude for accurate body weight determination.
6 Hold hand slightly above child while on scale and remain in close proximity to the child (Figure 43-1). Figure 43-1 To prevent injury when weighing the child, hold your hand slightly over infant and never turn your back on the child.	Prevents falls or potential injury. KidKare If infant/toddler scale is unavailable or child is extremely fearful or active, weight measurement may be accomplished by having a parent/family caregiver hold child in his or her arms on a stand-up scale. Weigh parent alone and then weigh parent holding child. To assess child’s weight, subtract weight of parent alone from weight of parent and child together.
7 Note and record child’s weight in kilograms on a notepad.	Allows accurate notation of weight. Weight in kilograms is used for accurate calculation of medication dosages.
8 Child’s diaper. Carefully remove child from scale, redress, and return child to family member’s arms or crib.	Places child in secure location.
9 Dispose of paper on scale and disinfect scale per institutional policy. Perform hand hygiene.	Reduces transmission of microorganisms.
10 Document weight on child’s growth chart and/or related records specific to care location.	Communicates findings to other members of the healthcare team.

PROCEDURE
Assessing Length of the Child 24-36 Months of Age or Older Child Who Cannot Stand Unassisted

Steps	Rationale/Points of Emphasis
1 Review medical record to note child’s age and previous length, if available. A child’s height is less than his or her length; if standing height/stature is plotted on a length chart, the perception is that the rate of growth has decelerated when, in fact, the issue is that the measurement has been plotted on an incorrect growth chart.	Serves as a baseline and enables nurse to detect changes in child’s length. Children younger than 2 years of age must be measured lying down because of the marked lordosis at that age and because the measurements will be recorded on length growth charts that are for children who are newborn to 24 months of age.
2 Perform hand hygiene.	Reduces transmission of microorganisms.
3 Place light drape or paper on flat surface or firm, flat length measuring board with a stationary headboard and a smooth sliding footboard at 90-degree angles.	Provides comfort and protects from microorganism cross-contamination.
4 Lay child in supine position, placing the vertex of the infant’s head at the top of the board and the soles of the feet firmly against the footboard. Recommend removing shoes, head ornaments, and hats. It is difficult to obtain reliable length measurements in term infants because of the natural flexion of the newborn infant and the cranial molding that takes place during the labor and delivery process. Clinicians should be aware of the magnitude of error in length measurements and interpret length measurements with caution.	Allows for full extension of body for accurate length assessment. caREminder
	Keep hand on child at all times to ensure child does not roll off of the flat surface or measuring board.
5a For scales with length devices attached or for measuring boards, position child in supine position with head against the headboard. Hold child’s head at midline point and extend legs fully. Ensure the child’s shoulders and hips are not rotated, the back is not arched, or the legs are not bent. Place feet flexed against the movable footplate (Figure 43-2). Figure 43-2 To obtain an accurate height measurement using a measuring board, the examiner ensures the infant’s head is against an end point and his or her hips and legs are fully extended on the measuring board. The measurement scale is calibrated from the head end point.	Full body extension is required for accurate measurement. KidKare Having a family member hold the child’s head provides emotional comfort for the child and assists with full extension of body.
5b For electronic length measurement devices, place child in supine position and follow manufacturer’s instructions for extending child’s body and ensuring accuracy of measurement.	It is important to consider the differences in the various measuring devices.
6a Using ruler attached to measurement device, read the measurement to the last completed centimeter.	Denotes upper and lower body measurement.
6b If there is no ruler attached to the measurement device, use a nonstretch tape measure from crown of child’s head to heel of child’s foot, alongside child’s body boundaries (Figure 43-3).	This is less accurate than length measuring boards and should only be used when other more accurate devices are unavailable.
Figure 43-3 To measure an infant’s length, stretch a tape alongside infant’s body from crown of head to heel of foot, ensuring that the infant’s leg is fully extended.
7 Note and record child’s length to the last completed millimeter on a notepad.	Allows accurate notation of length.
8 Reposition the child and repeat the measurement procedure. Use the mean of the two measurements as the child’s recorded length.	Measurement variance may occur due to child’s position. Mean of two or more measurements provides more accurate reflection of child’s length.
9 Carefully remove child from flat surface and return child to family member’s arms, crib or bed.	Places child in secure location.
10 Perform hand hygiene.	Reduces transmission of microorganisms.
11 Document length on child’s growth chart and/or related records specific to care location.	Communicates findings to other members of the healthcare team.
	caREminder
	Weight and length measurements should be shared with the family in kilograms and centimeters as well as in pounds and inches to assist understanding of growth.